多巴酚丁胺负荷试验中多普勒组织成像技术的应用价值  

Value of Doppler Tissue Imaging in Dobutamine Stress Test for Evaluation of Coronary Artery Disease

作　　者：郝力丹[1] 陈金玲[1] 郭瑞强[1] 周青[1] 

机构地区：[1]武汉大学人民医院超声科,武汉市430060

出　　处：《中国超声医学杂志》2005年第3期188-192,共5页Chinese Journal of Ultrasound in Medicine

基　　金：湖北省卫生厅课题 (No.WJ0 1 557)

摘　　要：目的　静息状态与大剂量多巴酚丁胺 (Dob)负荷状态下 ,采用多普勒组织成像 (DTI)技术观察冠心病患者室壁运动 ,探讨大剂量 Dob负荷试验中 DTI检测冠心病的应用价值。方法　采用 DTI测量大剂量 Dob负荷试验中 32例冠心病患者 (至少 1支冠状动脉主支狭窄≥ 5 0 % )静息状态、峰值负荷下侧壁、后室间隔、前壁、下壁心肌基底段、中段心内膜下心肌运动频谱 ,对照组 2 5例相应节段作对照。 DTI分析指标 :收缩期峰值运动速度 (Vs)。结果　选择性冠状动脉造影结果将冠心病组患者心肌节段区分为正常节段与缺血节段。静息状态下 ,冠心病缺血节段(abnormal,A组 )与对照组相应正常节段 (normal,N组 )间 Vs无显著性差异 ;与 N组比较 ,峰值负荷下 A组各节段 Vs明显降低 (P<0 .0 5 ) ;以选择性冠状动脉造影为诊断冠心病的金标准 ,将峰值负荷下基底段心肌 Vs≤ 11.5 cm/ s,中段心肌 Vs≤ 9.5 cm/s为诊断冠状动脉狭窄的截断值 ,DTI结合大剂量多巴酚丁胺负荷试验诊断冠状动脉狭窄的敏感性、特异性、准确率分别为 85 .7%、84 .0 %、 84 .8% ;与常规多巴酚丁胺负荷超声心动图中室壁运动评分 (WMS)比较 ,DTI结合大剂量多巴酚丁胺负荷试验诊断冠状动脉狭窄的特异性与其并无显著差异 ;而敏感性、准确率显著增高 (P<0 .0 1)。结?Objective The purpose of this study was to investigate the value of Doppler tissue imaging in dobutamine stress test for evaluation of coronary artery disease.Methods High dosage dobutamine stress echocardiography (DSE) was performed in 32 patients with coronary artery disease (CAD) each of whom had at least one coronary artery stenosis≥50%,and 25 controls.At the baseline and peak stress,DTI sample volume was located on the endomyocardium at the basal and middle segments of each wall.DTI indices included peak velocity in systole (VS).Results Segments in patients with CAD were divided into normal and ischemic ones by the results of selected coronary angiography (SCA) At baseline,there was no significant difference in VS between the corresponding segments of the controls (normal,group N) and at the ischemic segments of patients with CAD (abnormal,group A) Comparing with group N,group A had significantly decreased Vs( P <0 05);Taking SCA as the golden standard of diagnosing CAD,assuming Vs≤11 5 cm/s in basal segments and Vs≤9 5 cm/s in middle segments as the cut-off point,the sensitivity,specificity and accuracy of DTI combined with DSE were 85 7%,84 0% and 84 8%,respectively Comparing with wall motion score (WMS),Vs had higher sensitivity and accuracy ( P <0 01),but same specificity Conclusions Use of DTI in dobutamine stress test can improve the sensitivity and accuracy of DSE,but with small effect on specificity of DSE

关 键 词：多巴酚丁胺负荷试验 多普勒组织成像技术 应用价值 多巴酚丁胺负荷超声心动图 冠状动脉狭窄 选择性冠状动脉造影 冠心病患者 静息状态 室壁运动 大剂量 显著性差异 DTI 敏感性 特异性 准确率 运动频谱 心内膜下 运动速度 

分 类 号：R445.1[医药卫生—影像医学与核医学]